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On the Third Hand: Sick people

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At least in public, Democrats and Republicans are both playing annoying, cynical politics with efforts to provide reasonably predictable health care for people with serious health problems.

Rep. Joe Pitts, R-Pa., chairman of the House Energy and Commerce health subcommittee, continued the cycle of partisan hair-pulling by introducing H.R. 1549, the Wrap Help Sick for Americans in Democratic Poison Act bill, a week ago.

The bill would perform the noble, admirable service of keeping the Pre-existing Condition Insurance Plan (PCIP) application process open until Dec. 31 by taking a cash away from the discretionary fund that U.S. Health and Human Services (HHS) Secretary Kathleen Sebelius is trying to use to get the new Patient Protection and Affordable Care Act (PPACA) health insurance exchanges up and running.

PCIP (pronounced “P-sip”) is an ill-fated PPACA risk pool program for uninsured people with health problems.

Even though PCIP let people with AIDS and cancer pay the same premiums healthy people pay for medical coverage, it enrolled fewer uninsurable people than expected; spent astronomical sums (an average of $225,000 per year) on the claims of the sickest 4.4 percent of the people who did enroll; let its dog eat the forms submitted by agents seeking the $100 PCIP enrollment incentive fee; and probably had other problems the U.S. Government Accountability Office will tell us about later.

But the program did give “uninsurable people” and their providers the sense that they had some kind of insurance that eventually would pay a reasonably high percentage of eligible claims. (Any program that was paying $225,000 per year in claims for 4.4 percent of its insureds must have been paying a significant number of claims.)

The program freed uninsured sick people from trying to raise money for $300,000 operations by competing to be cute enough or tragic enough to inspire providers to donate care, or to inspire friends and strangers to organize successful highly successful bake sales.

PCIP was supposed to be taking applications until Jan. 1, 2014, when PPACA is set to eliminate insurers’ use of personal health information in decisions about whether to issue coverage, and sharply restrict use of personal health information in pricing, 

Officials at the Center for Consumer Information and Insurance Oversight (CCIIO) suddenly shut the federal program down during a conference call in February, and required managers of state-run PCIP programs to shut off their application processes by March 2.

Officials at CCIIO’s parent, the Centers for Medicare & Medicaid Services, and officials at the parent of CMS, the U.S. Department of Health and Human Services (HHS), said cutting off access to PCIP for about nine months because sick people would get permanent access to coverage Jan. 1, 2014.

Instead of screaming bloody murder and at least insisting on the government providing a short transition program for people who were getting ready to send in their PCIP applications when the program died, people who call themselves representatives for consumer advocacy groups echoed HHS officials. The allegedly independent consumer group reps robotically declared that sick people would be better off when they got permanent access to good coverage through PPACA.

The HHS officials and consumer reps seemed to be asking, “Why should people with leukemia need health insurance insurance to get broken legs fixed and inflamed appendices removed between now and Jan. 1, 2014? Can’t they have their girls postpone the start date of any need for urgent care till 2014?”

So, instead of calling for help and at least trying to ask for what PPACA supporters would have thought to be an acceptable source of PCIP enrollment continuation funding, HHS officials and “consumer reps” ended up sounding like the sorts of people they would normally organize protests against.

Now Pitts and colleagues have filled the compassion void with a bill that would keep PCIP open for new enrollees by suffocating CCIIO efforts to get help with telling consumers about the new PPACA exchanges.

Few Democrat who are even a little bit fond of PPACA, or at least feels obligated to pretend to be, could vote for that bill.

On the one hand, maybe this is all for public show on both sides. Maybe, after Pitts and the folks at HHS thump their chests and gouge out each other’s eyeballs for a few days to make the folks at home happy, Senate Majority Leader Harry Reid will figure out a way to get a clean PCIP enrollment extension amendment into a giant, must-pass bill, at midnight, in a smoke-filled backroom, in a tomb in a graveyard under the facility where the alien specimens are kept at Area 51.

On the other hand, this kind of use of sick people as human shields to try to kill PPACA, or at least make the Democrats look bad, and the Democrats’ use of apparent lack of concern about sick people to shield PPACA implementation funding, are just plain unseemly. Maybe one place to start would be to discourage use of poison-pill bill provisions by requiring anyone filing a bill to get a “That’s not poison” statement from at least five members of the opposing party. 

On the third hand, maybe this is actually a bipartisan approach to managing care costs. Just keep PCIP closed to enrollees, and encourage the types of people who file $225,000 per year in claims die quickly, and maybe that will help reduce total national health care spending a bit in 2014 and later years. 

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